Reference — Med-Surg
Peripheral Vascular Assessment Reference
The vascular exam answers two questions: is blood reaching this limb, and is it draining? Pulses, capillary refill, the 6 P’s, and the ABI answer the first; skin findings sort arterial from venous disease.
Educational use only. Acute limb ischemia (sudden 6 P’s) is a vascular emergency — escalate immediately. ABI interpretation and Doppler use follow facility protocol. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Pulse Sites & Grading
Palpate and compare bilaterally — asymmetry is the alarm. Lower-limb sites: femoral, popliteal, posterior tibial, dorsalis pedis. Mark a non-palpable pulse’s Doppler location so the next nurse rechecks the same spot. Always document by site and grade, both sides.
| Grade | Meaning |
|---|---|
| 0 | Absent — not palpable |
| 1+ | Diminished/weak, barely palpable |
| 2+ | Normal, expected |
| 3+ | Increased, full |
| 4+ | Bounding |
The 6 P’s of Arterial Compromise
Sudden onset of these = acute limb ischemia, a vascular emergency. Paralysis and paresthesia are late, limb-threatening signs.
Ankle-Brachial Index (ABI)
Highest ankle systolic pressure ÷ highest arm systolic pressure, measured with a Doppler. Lower values mean worse arterial supply:
| ABI | Interpretation |
|---|---|
| 1.0 – 1.4 | Normal |
| 0.91 – 0.99 | Borderline |
| ≤ 0.90 | PAD confirmed |
| < 0.50 | Severe — rest pain, threatened limb |
| > 1.40 | Non-compressible, calcified vessels (often diabetic) — also abnormal |
Arterial vs Venous Skin Findings
Arterial insufficiency: cool, pale, shiny, hairless skin; thickened nails; pallor on elevation and dependent rubor; diminished/absent pulses; round “punched-out” painful ulcers on toes and pressure points.
Venous insufficiency: warm skin, brownish hemosiderin staining around the ankles, edema, present pulses; irregular, ruddy, weepy, less-painful ulcers at the medial malleolus (gaiter area).
The positioning consequence: arterial legs do best neutral or dependent; venous legs do best elevated with compression — and compression is contraindicated when arterial supply is poor.
NCLEX Pearls
- ✦Always compare pulses bilaterally — asymmetry is the finding.
- ✦Sudden 6 P's = acute limb ischemia, a true emergency; paralysis/paresthesia are late and ominous.
- ✦ABI ≤0.90 confirms PAD; >1.40 means calcified vessels (often diabetic) and is also abnormal.
- ✦Cool/pale/hairless/diminished pulses = arterial; warm/brown-stained/edematous/pulses present = venous.
- ✦Don't apply compression to a limb with poor arterial supply — verify before you wrap.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →